European Food Consumption Validation

Within the context of the EFCOVAL (European Food Consumption Validation) project a workshop was organized with the title “Pan-European Food Consumption Surveys – for Standardized and Comparable Transnational Data Collection”. The 2-day workshop preceded the EFCOVAL closing conference in September 2009 in Utrecht, the Netherlands. About 50 participants, from international organizations, universities, and research institutes in 18 European countries attended the workshop. About half of the participants were involved in the EFCOVAL project.

The workshop started with a welcome and general introduction by Dr Marga Ocké. She explained the aims of the workshop:

1. to create support for pan-European food consumption surveys or for harmonization of national food consumption surveys;
2. to list and discuss possibilities and barriers for harmonization or for implementation of a pan-European food consumption survey;
3. to inform on the EPIC-Soft software for collecting 24-h dietary recalls and 4) to discuss potentials and requirements to use EPIC-Soft in the context of pan-European and national dietary monitoring.

The first day of the programme focussed on dissemination of information with regard to needs and requirements to harmonize food consumption data for Europe and on EPIC-Soft. The programme of the second day consisted of informal discussions related to the workshop aims.

Dr Evelien de Boer presented the background and rationale of the EFCOVAL project. The EFCOVAL project followed in the footsteps of the EFCOSUM project in which the 2x 24 hour diet recall was recommended as dietary assessment method for pan-European food consumption surveillance. Moreover, this project advised that EPIC-Soft is the preferred software to collect 24-hour recalls in all EU countries but should be upgraded and adjusted for the new purposes.

The view of WHO-Europe with regard to the needs and requirements for pan-European food consumption data was presented by Mrs Trudy Wijnhoven. WHO-Europe addresses several major nutritional challenges, like obesity prevention. In this context the monitoring of progress on improving nutrition and physical activity and preventing obesity is actively undertaken. WHO works on the establishment of a European database by inclusion of all available data on food availability, food consumption and nutrient intake. Harmonized dietary data would have important advantages for comparing countries. Therefore, the development of standardized protocols – taking into account valuable existing data sets – is needed for future data collection. In addition, capacity building and training in the conduct of food consumption surveys is important.

Similarly Mr Davide Arcella presented EFSA’s needs and plans for pan-European food consumption data and food consumption monitoring. The availability of accurate and detailed food consumption data is of major importance for risk assessment done by EFSA. Therefore, the collection of data on food consumption in Europe is an essential task of EFSA. Apart from the collection of existing food consumption data, EFSA takes a leading role in the harmonization of pan-European food consumption data collection. As a first step, EFSA develops guidelines on methods and protocols for national food consumption data collection in the view of a pan-European dietary survey. EFSA hopes to obtain funding to start national surveys on children and adults according to these guidelines. The intention is that in the period 2012-2017 all EU member states conduct such a survey.

Dr Heinz Freisling gave an overview of dietary assessment methods currently used in national dietary monitoring surveys and other studies. He showed that in studies on adults more countries apply 24-hr diet recalls than food records, whereas for children the food record is used more often. In addition, current trends in nutritional epidemiological studies were highlighted. These include a focus on open-ended methods, new technologies and a combination of several methods like the food frequency questionnaires with 24-h recalls and 24-h recalls with food records. Promising new developments identified are web based methods for 24-h diet recalls, and the use of PDA’s with camera function in food records. Dr Freisling concluded that further technological development and studies on validity and feasibility aspects are important.

In the afternoon session Dr Nadia Slimani focussed on EPIC-Soft. Her lecture included the rationale, concept and ongoing work of the EPIC-Soft methodology, originally developed by the International Agency for Research on Cancer (IARC) for the EPIC-study. The advantages of EPIC-Soft are: a standardized face-to-face or (alternative) telephone interview, standardized procedures to classify, store, retrieve and export data, 13 existing European translated versions, a flexible system to prepare new country- or study-specific versions, and validated measurements. In the EFCOVAL project the software has been upgraded with new specifications and functions and updated to modern IT standards.

After this, Mrs Elly Buurma and Mrs Maryse Niekerk showed a demonstration movie to illustrate the EPIC-Soft 24-h recall interview. The interview setting as well as the EPIC-Soft screen shots and related tools were shown. All steps of the interview were elucidated: the collection of general information, the quick list, the description and (partly automatically adapted) quantification of foods and recipes, intake of dietary supplements and overall quality control. Although the software maximizes a structured and standardized approach, it was illustrated that trained and experienced dieticians are needed to ensure good quality for the rather complex open-ended interview.

Experiences with handling of the EPIC-Soft databases were presented by Dr Jan van der Laan. These include preparation aspects of the almost 60 EPIC-Soft database files that are needed to make or update a country specific version of EPIC-Soft. Moreover, the data processing that is needed, after the interviews have been completed, was discussed. This includes the combination of various interview datasets, checks for incorrect values, correction of these values, handling of missing values, merging of consumption data with other data like food composition databases, and data analyses. Overall it is recommended not to underestimate the work involved in data processing.

Dr Inge Huybrechts subsequently discussed the evaluation of the EPIC-Soft 24-h dietary recall interview. The evaluation was based on an inventory of expertise from previous surveys and the respondent’s viewpoint. She showed that EPIC-Soft has already been used successfully in different study settings, in different study populations, and for nutritional and exposure assessments for chemicals. In three countries it is used for national dietary monitoring. The mean interview time is 20-43 minutes. Within the EPIC-study, it was most difficult to take a 24-h dietary recall interview from the oldest population group. The viewpoint from the respondents, the interviewers and other researchers is generally positive. It might be considered to increase the duration of the interviewer training to improve quality of the interviews.

The final presentation of the first day was given by Mrs Corinne Casagrande and Dr Nadia Slimani. They focussed on the future use, dissemination and perspectives of EPIC-Soft and presented the concept of the EPIC-Soft web-based Methodological Platform (EMP). The platform includes various components: maintenance and settings, the EPIC-Soft interview software, interview management, communication and online help and guidelines. It includes an organisational infrastructure for international studies. IARC maintains the ownership and copyright on the EPIC-Soft methodology and related tools and versions. For future, IARC welcomes partnerships in possible pan-European monitoring studies under conditions that are still under discussion. There are plans for the implementation of the EPIC-Soft web-based Methodological Platform and for further development of EPIC-Soft and related tools.

From the discussions on the second day, there was a general agreement that with EPIC-Soft it is possible to collect detailed and standardized food consumption data. This makes it a suitable method for pan-European food consumption surveys aimed at nutritional issues and for many food safety issues as outlined for EFSA and WHO. The software is about ready for implementation, although some further work was identified.

In the discussion groups it was emphasized that a pan-European dietary survey not only requires a standardized tool for dietary assessment but needs standardization of all other tools and procedures as well. It was stressed that implementation of pan-European survey requests thorough preparation of all aspects involved. Therefore involved organisations should plan realistically and 2011 seems too optimistic as starting year for actual data collection.

The participants felt that collaboration between national and international organizations is needed for such pan-European food consumption surveys. From the national perspective various potentials and barriers were identified. Countries with running surveys and experience in food consumptions surveys and methods are often concerned about changing their system. Countries that are ready to start such surveys are open to external guidance. Whereas countries without any monitoring system need help and capacity building. The proposed strategy towards pan-European food consumption surveys is to start with a limited number of willing countries. It is likely that by then more countries will be interested (snowball effect). For success, flexibility in national aims seems important.

The provided information reflects a summary of the presentations and discussions during the EFCOVAL workshop as perceived by the authors. The Community funding under the Sixth Framework Program for the EFCOVAL project is acknowledged (FOOD-CT-2006-022895).The Community, EFCOVAL consortium, speakers, and participants at the EFCOVAL workshop are not liable for any use that may be made of the information contained therein.

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